TERMS AND CONDITIONS OF SERVICE
The evaluation consists of a specific evaluation to identify areas of dysfunction. An evaluation consists of an interview, observations and standardized assessment. After the evaluation, recommendations or referrals will be made if necessary. It is important to note that the findings and results of the evaluation may be shared with other health care professionals.
THERAPY AND CANCELLATIONS
Therapy takes place on a regular basis if deemed necessary after the initial evaluation. Therapy will focus on the areas of dysfunction identified during the initial evaluation. Therapy will take place in a group setting, and/or on an individual basis if needed. Please note occupational therapy is not compulsory, and the patient can refuse treatment at any time. It is also important to note that the patient is free to attend any occupational therapist that is available to them. In the case that the patient needs to cancel a standing appointment for treatment from the occupational therapist, the cancellation must be done 24 hours in advance. If less than 24 hours’ notice is given by the patient or the person responsible for the account for the cancellation of the appointment the full treatment fee will be charged.
The patient’s information will be treated as confidential and will not be shared without written permission from the patient.
ACCOUNTS AND TARIFFS
Services rendered by the occupational therapist can be claimed from medical aid. The therapist will claim directly from the medical aid on behalf of the patient unless otherwise arranged. Correct medical aid details must be submitted to the practice. Any changes to personal or medical aid details must be submitted to the practice in writing. If the medical aid fails to pay the account, you will be expected to pay the amount in full. Where the patient is a minor, their guardian/parent will be expected to pay the amount in full. In these cases, the person that signs the terms and conditions form will be fully responsible for the payment of the account. I agree that Mandy Mitchell Occupational Therapy is permitted to make the treatment codes, ICD-10 codes and information related to the invoice known to the individual indicated as the person responsible for the account, to the person sending the account and the medical aid. I give consent that my personal details and ICD 10 codes will be shared with administration and employees of Mandy Mitchell Occupational Therapy, the medical aid, companies involved in collection of outstanding amounts and companies used for note taking. Payment terms are 30 days, after which interest will be charged on accounts outstanding longer than 30 days. The interest is directly payable by the patient. Therapy will be discontinued on accounts outstanding longer than 60 days, and these accounts will be handed over to an attorney without further notice.
I consent to my personal and related account information being shared with the collections agency/ attorney engaged to assist with the collection of the outstanding amounts. The patient will be responsible for the payments of any costs, as on attorney and client scale, incurred by the attorneys and the practice in collecting the outstanding amounts. Where payments are made directly into the practice account or via internet banking, proof of payment must be mailed or delivered to the practice on the day of payment. In the event of legal action being instituted against me, I agree to pay all the costs as between attorney and client, including collection and tracing fees. In the event of any legal actions taken against me, I consent to the Magistrates Courts Jurisdiction for all accounts instituted against me.
Compliance with The Protection of Personal Information Act (POPIA)
I understand that this practice takes the privacy of its patients very seriously and has implemented reasonable security measures to guard against the unauthorised disclosure of my private patient information. This document constitutes a contractual agreement with the practice to protect all personal information in confidence. We will use the patient’s information only in relation to providing healthcare, which means that we may also use the information when we interact with your Medical Aid or when processing your account. I confirm that all information supplied by myself is true and correct and that I am responsible for updating my information to ensure that it is correct and for not providing any false information. I acknowledge that my personal and special personal information will be kept for the required storage and retention periods according to and in line with legislation periods applicable to the practice and the medical/ healthcare industry. In the event of a third-party request for confidential information from the practice, and in doubt regarding the safety of confidentiality processes, the practice may insist on following the processes stated in the Promotion of Access to Information Act (PAIA). Requests for access to information kept by the practice can be lodged with the Information Officer of the practice.
I acknowledge that my patient information may be disclosed by the practice in response to a specific request by a law enforcement agency, subpoena, court order, or as required by law. I accept that clinical information obtained in sessions may be used for research purposes, presented anonymously at professional meetings and/or published in journals or textbooks. I understand that at no time will any identifying information be used and that I may object to my de-identified information being used in any circumstances.
Permission is hereby given that the patient may be evaluated/treated by Mandy Mitchell or any occupational therapist employed by Mandy Mitchell. I have read the terms and conditions of service and fully understand them I also authorize Mandy Mitchell Occupational Therapy or the insurance company to release any information required to process my claim.